Exploring a Complex Systems Map of Gender

Avgi Saketopoulou provides a stunning integration of theory, empirical studies, and clinical work. She continues the process by which a broadening view of transsexual people both enriches our understanding of gender and helps us assist them with the challenges they commonly face. It is fitting that the paper won the Roughton Award, not only because of its excellence, but because, like the existence of that award itself, the paper marks a sea change in psychoanalytic outlook and practice from a time when analysts acted as part of the oppressive dominant community by pathologizing sexual and gender variation to a time when analysts have largely recognized that these variations represent life ways deserving of respect and support, while at the same time maintaining a commitment to an understanding of their multiple significance for people.

In late-nineteenth-century Europe and the United States, the possibility of separating sexual activity from reproduction, combined with the relaxation of antisexual moral attitudes and the recognition that sexual frustration contributes significantly to psychological distress, converged to create an intellectual and medical environment that invited exploration of the complexities of gender and sex. In the latter part of the nineteenth century Kraft-Ebing (1886) conceptualized the variations he found as forms of pathology, thereby moving discourse about sexuality away from morality and law and toward medicine. He began a catalog of the range of human sexuality and gender. Sigmund Freud and Havelock Ellis continued this exploration, noting that the variation in manifest behavior that was considered immoral or pathological in fact reflects processes that are part of ordinary human psychology. Psychoanalytic thinking appears to have significantly regressed, in the sense of moving toward more prescriptive attitudes toward sexuality, beginning in the 1920s when Wilhelm Reich (1924) and Karl Abraham (1924) theorized rigid developmental lines for normal sexuality and equated overall psychological normality with the development of sexuality along those lines. That attitude became particularly problematic with regard to the psychology of women and same-sex desire, about which psychoanalysts like Helene Deutsch (1945) and Edmund Bergler (1956) created a vision of mental health that had the impact of old-fashioned moralism joined with the added force of medical and scientific authority. It was not until the 1970s that feminist, gay, and eventually queer critiques of psychoanalytic thinking, combined with increased descriptive data regarding sex and gender, moved analysts toward a progressively less knowing, ever more exploratory and curious attitude toward these matters.

As Saketopoulou correctly asserts, in the very recent past a person born with male anatomy who believed herself to be female would automatically be assumed to be suffering from significant psychopathology by virtue of this belief, and while many analysts might have recognized their inability to relieve this supposed psychopathology, they would have conceptualized any difficulties from which such patients suffered as the product of psychodynamics sharing an origin with the patient’s beliefs about her gender. Putting aside such preconceptions, which can be done only by recognizing the intellectual, institutional, and personal psychological pulls to retain them, Saketopoulou could remain open to locating the problems faced by her patient Jenny in terms that reflect the child’s own concerns rather than attempting to “normalize” her. (While it would take us too far afield to explore the idea fully, I will mention that the difference between an attitude that regards the therapeutic aim of analysis to be a movement toward normalcy and one that sees its goals as involving an increased capacity to deal with what the analysand views as problems of living must be faced squarely when exploring the effectiveness of psychoanalysis and thinking about its aims.) It is within this context of relative liberation from preconceptions about a child who knows herself to be a girl while having a boy’s anatomy that Saketopoulou is able to engage the awful dilemmas faced by her young patient.

Saketopoulou invites us to free ourselves from a point of view that can only hinder our understanding of transsexual patients. She wisely comments that “the search for etiological underpinnings treats transsexual experience as a unitary phenomenon rather than as the end point of heterogeneous developmental pathways and complex compromise formations. . . . Gender aggregates polyvalently, not lending itself to being theorized generically” (p. 775). This is a particularly important statement because, as in many other situations, especially those involving gender and sexuality, the conviction that common developmental end points are the result of common developmental processes leads to a mutually reinforcing discourse, of no clinical value, about homogeneous etiologies and outcomes, thereby confusing the issue and precluding any exploration of their heterogeneity. The notion that shared outcomes reflect shared developmental paths was clearly shown to be wrong by Thelen and Smith (1994) with regard to walking: children learn to walk through extremely varied developmental routes, even though the end points, the actual way in which they walk, are very similar. (This unfortunate confusion in psychoanalytic thinking can be traced to Freud’s ideas on developmental pathology, in which, to take an example, the equation of obsessive-compulsive character features with problems in anal-phase development inhibited the exploration of both the varied phenomenology of obsessive-compulsive symptoms and their varied etiologies. This equation of the end point of development with the pathway that has led to it in turn reflect Freud’s early education in the embryology of his day (Sulloway 1979.)

Having put aside these preconceptions, Saketopoulou argues that we should treat the gender of transsexuals “not as symptom but as a viable subjective reality” (p. 775). This is both pragmatic and theoretically sound. As Freud showed in the series of works starting with The Interpretation of Dreams in 1900 and ending with Jokes and Their Relationship to the Unconscious in 1905, from the point of view of psychodynamics there is essentially no difference between symptoms and a variety of “normal” psychological configurations. To label something as a symptom means to regard it as intrinsically undesirable and the potential object of eradication through a therapeutic endeavor. Labeling transsexual states as symptoms places the analyst in the undesirable position of passing judgment for the patient about what is wrong and/or distressing, while at the same time it tempts the analyst to engage in the virtually impossible task of altering a person’s gender. A similar situation has been widely explored with regard to same-sex desire, where efforts at therapy to eradicate that desire have now almost universally been recognized as both wrong-headed, in that same-sex desire is not in itself a symptom, and practically undesirable, in that these efforts have generally failed and have themselves caused enormous distress.

Saketopoulou then asks why, if transsexuality is not in itself a symptom, is Jenny, like many transsexual people, so distressed? She suggests that “the ensuing emotional difficulties . . . often result from the traumatic and unmentalized impact of being trans rather than being its originary cause, as is often assumed” (p. 780). She observes that “when gender is tenaciously conflated with bodily morphology, such individuals often feel unseen and unknown,” thus suggesting a plausible interpersonal developmental contribution to the distress commonly observed in trans individuals (p. 779). “Feeling unseen and unknown” is, of course, a product of how the trans person is perceived; the feeling arises from the confluence of actual attitudes of those in the environment and the expectations brought to a situation by the individual. For the transsexual person the expectation of remaining unseen and unknown certainly arises in significant measure from plausible expectations, as the very existence of transsexuals threatens the foundational worldview of many of the people encountering them. The example of Chiland’s “so goodbye to the difference between the sexes and between the generations . . . the ‘sexual compass’ of psychoanalysis” (p. 799) wonderfully and horrifyingly illustrates the threat that transsexuals pose when clear gender difference is regarded as foundational to an organizing worldview.

Although she does not develop the idea in this paper, Saketopoulou’s rejection of binary gender gains strong support from thinking about gender from the points of view of complex systems and nonlinear dynamic systems theory. Harris (2005) has shown how the idea of gender can be conceptualized in terms of “attractors.” If we imagine representing aspects of gender in a space whose multiple dimensions correspond to aspects of what we ordinarily think of as gender, such as gendered anatomical features, gendered social roles conventional in a given community, the sex of objects of desire, etc., we could think of gender development as pathways through this gender space, and could conceptualize individuals at any given time as located somewhere within that space. Some of these pathways are particularly common because a variety of forces tend to keep the individual on (or nearly on) them. The two most common of these, femininity and masculinity, represent broad pathways with ill-defined and context-dependent boundaries, along which most individuals travel. These gender attractors may overlap, and movement from one attractor to another is at times possible if some factor displaces the individual from one gender attractor to another. Gender attractors are, for whatever reasons, particularly stable and will be more common and more easily recognized. It should be noticed, however, that a powerful stabilizing factor for a gender attractor within a community is the recognition of that attractor by the community, so that, for example, the recognition of what is now labeled transsexuality in Europe and the United States has tended to stabilize that attractor and led to certain forms of it becoming more visible and stable then they were even a short time ago.

When individuals live under an attractor that is associated with great pain or when a gender attractor is sufficiently unstable that an individual cannot feel secure about being on a specific attractor, the resulting anxiety leads to defensive operations. I suspect both of these factors affected Jenny. On one hand the presence of male genitals made her a defective girl and caused anxiety for that reason; at the same time, the presence of those genitals brought into question her belief that she was a girl at all and so made her anxious by destabilizing her view of herself. Defenses designed to maintain the stability of the attractor (e.g., to maintain Jenny’s self-description as a girl) commonly include elements that interfere with the attractor’s evolution and the exploration of alternative attractors or of any possibility that might call her gender into question. To ask the question, “How is it that I am a girl with boy’s genitals?” much less to explore possible answers to that question, threatened to radically destabilize the child’s organizing view of herself. To ask the question, “How can I be an admirable girl with boy’s genitals?” is to risk the possibility that she cannot be successful as a girl. Because to ask either of these questions and explore possible answers would endanger any sense of psychological well-being, she had to rigorously protect herself from anything that might raise them. And when the questions cannot even be raised, finding a satisfactory answer is of course impossible, rendering Jenny’s terror self-perpetuating. Only when Jenny, with the help of her analyst, is able to consider the possibility that she can be a girl with a penis is she able to enter into a process of liberatory mourning for the perfect girl she should have been.

Saketopoulou brings to her work visions of development that provide her and her patient the opportunity to explore developmental possibilities that could not even be considered were one to assume the existence of straightforward developmental lines (at least in a given culture). While she notes that the population of transsexual children ultimately bifurcates into a group of “persisters” (people who experience their natal genitalia as so inconsistent with their self-experience that they continue to seek surgical and hormonal intervention) and “desisters” (people who do not experience such a need or who find that the disadvantages of these procedures outweigh their benefits), she notes also that there is no way to differentiate the two groups in childhood. This sort of developmental bifurcation is of a type that has been well studied in the field of nonlinear dynamics, a field that has provided a language in which analysts can conceptualize the development of complex interacting systems in a manner that is impossible if one accepts the sequential models of development traditionally used in psychoanalysis (Galatzer-Levy 2004). Imagine a developmental path as a highway that at some point divides, one branch going toward divergent development, the other toward persistent development. Until shortly before the highway actually divides, very little can be predicted about the direction in which the cars will go from their position on the roadway, except that they will continue along one or another leg of the bifurcation. As the bifurcation is approached, it becomes less likely that the cars will move from a lane leading to one side of the bifurcation to another, but the search for early determinants of which way the vehicle will go (e.g., by observing the vehicle several miles distant from the bifurcation) will in large measure be futile. As systems increase in complexity, the difficulty of prediction becomes ever greater; thus, for a system like gender, the bifurcation between persisters and desisters is impossible to predict except in unusual circumstances. That it would make life easier for all concerned if we could predict the child’s adult wishes and thereby avoid unneeded and problematic hormonal and surgical intervention, or intervene earlier and spare the youngster the distress associated with having the “wrong” body, does not alter the fact that such prediction is not possible and very likely never will be.

In “Mourning and Melancholia” Freud describes the fractionating process in which aspects of the object are recognized, intensely cathected, and then either further integrated in the self or put aside, often after a process of further fractionation. When this occurs, one might frame the process either as the individual’s creating a new type of boundary or interdigitation of boundaries between self and object or, alternatively, recognizing that the nature of the boundary was all along different from how it appeared. The process of mourning is thus a process of reintegration through reimagining the object, its relationship to the self, and the nature of associated boundaries. It is possible only when the pain of recognizing existing boundaries can no longer be endured. Because her analyst was able to live with the realization that the boundaries usually drawn between masculinity and femininity could be maintained for Jenny only at incredible cost and was able to communicate to the child that exploring those boundaries need not cause her overwhelming distress, Jenny was freed to do the work of mourning and to begin exploring visions of herself with an appreciation of the creative possibilities that come from such work.